13th May 2024
At Taking Action on Addiction, it is one of our core beliefs that addiction is not due to a series of poor choices or a lack of willpower. We know that addiction emerges from a complex interplay of factors that are as diverse and varied as the individuals it affects. Physical issues such as brain function anomalies, developmental disorders, and genetic predispositions lay a foundation that can be triggered or exacerbated by environmental influences like childhood trauma, socio-economic circumstances, cultural settings, and personal life events.
In this context, addiction is a multifaceted health issue, deeply rooted in neurobiological, psychological, and societal elements - the bio-psych-social model. Moreover, addiction frequently co-occurs with other conditions, particularly those involving mental health and as it’s now coming to be understood, neurodiversity.
Conditions such as ADHD, anxiety, and depression often run parallel to addictive behaviours, suggesting a growing area of common ground. At the heart of our philosophy at Taking Action on Addiction, we maintain that addiction is not a deliberate choice but rather a condition that develops—sometimes rapidly, sometimes gradually—as a result of this unique combination of factors, many of which are beyond an individual's control.
Acknowledging the complexity of addiction is crucial not only for those experiencing it but also for the broader community and professionals involved in treatment and support. Our perspective fosters a more compassionate and effective approach to addiction recovery, emphasising the need for comprehensive, long-term strategies that address the many influences contributing to the development of addictive behaviours.
Personal Insights into ADHD and Recovery
My own journey of recovery from addiction has included many examples of how sustained efforts, working the programme, and being a member of a like-minded community and fellowship really do work. However, there were certain things that I continued to struggle with - for example, heightened sensitivity and intense emotional responses seemed resistant to the strategies, tools and healthy coping mechanisms I had learned over the years. The diagnosis of ADHD later in life provided a crucial context for these experiences, revealing that my emotional and behavioural patterns were not merely remnants of past struggles, personality failures or somehow working the programme incorrectly - but were deeply influenced by ADHD.
ADHD affects the brain’s executive functions and emotional regulation, making it difficult for those with the disorder to manage their time, complete tasks, and handle their emotions. This can lead to a perpetual cycle of unmet expectations and frustrations.
A lesser-known aspect of ADHD currently known as Rejection Sensitive Dysphoria (RSD) can be particularly difficult to manage. RSD is characterised by intense emotional reactions to real or perceived rejection, criticism, or failure, and profoundly affects how individuals regulate their emotions, impacting their overall emotional health. While RSD is primarily recognised in those with ADHD, it is also becoming evident that similar emotional responses can occur in other disorders as well.
ADHD, Addiction, and Dopamine Dysfunction
One of the core characteristics of ADHD is a dysfunction in the brain's reward system, which parallels the mechanisms seen in addiction. In both conditions, there is an intensified pursuit of substances, activities and behaviours that trigger the release of dopamine—a neurotransmitter essential for pleasure and motivation. In ADHD this can be more subtle, sometimes known as "stimming" (stimulating) - or can sometime present as the individual only being interested in the things that they find "fun". Individuals with ADHD often have lower levels of dopamine or impaired dopamine receptors, leading them to engage in a cyclical pattern of seeking behaviours that momentarily spike dopamine levels. This quest for dopamine release is not just about seeking pleasure; for some with ADHD, particularly those with certain subtypes, it's a necessary means to maintain focus and engagement.
People with ADHD often have unstable dopamine levels, which compels them to seek activities that boost dopamine as a way to maintain focus and manage tasks. This constant pursuit of stimulation and rewarding experiences can become a compulsive behaviour that's hard to regulate and might lead to addiction. The search for immediate gratification, whether through substances like nicotine, alcohol, or drugs or through behaviours such as risky sexual activities or gambling, may be satisfying at first but soon turns into a relentless cycle of dissatisfaction and an increasing need for more intense stimulation. This striking similarity with characteristics of addiction suggests a high-risk genetic or other predisposition which amplifies the likelihood of developing substance use disorders and addictive behaviours, as these activities or drugs also trigger a temporary increase in dopamine, which briefly eases the cravings.
The Impact of Rejection Sensitive Dysphoria (RSD)
As previously mentioned, heightened sensitivity associated with RSD can lead to substantial distress. Individuals with RSD may experience profound discomfort and emotional pain, often from situations that might seem minor or insignificant to others. This can complicate personal and professional relationships, leading to avoidance behaviours and a heightened risk for depression and anxiety. In the broader conversation about addiction, the role of RSD is particularly pertinent. The emotional turmoil associated with RSD can drive individuals to seek relief in unhealthy ways, including substance use or addictive behaviours, as a coping mechanism or self-soothing, to temporarily alleviate their emotional pain. Understanding and addressing RSD is crucial for those with ADHD and other overlapping disorders, as it can be a pivotal factor in both the development and recovery from addiction.
Emotional Dysregulation in ADHD
ADHD is frequently associated with emotional dysregulation, a condition that affects how individuals manage and respond to feelings and emotions. This dysregulation often manifests as an inability to handle heightened emotions. Individuals with ADHD may find themselves unable to manage their responses effectively, experiencing intense feelings of frustration, anger, or sadness for seemingly little or no reason. This can make typical daily interactions and responsibilities challenging, as the emotional responses may not match the context or severity of the situation. A typical solution for someone with addictive tendencies may be to want to self-sooth or self-medicate – which, ironically, can often lead to addictive behaviours that would end up being labelled or becoming, self-destructive – the opposite of the original intention.
The Impact of Overstimulation
For many with ADHD, the world feels overwhelmingly intense; noises can be louder, lights brighter, and experiences more emotionally charged. This constant overstimulation can lead to a state of chronic stress or anxiety, where even ordinary environments feel hostile or unmanageable. This can often be misinterpreted as social anxiety. The strain of continual overstimulation often pushes individuals toward finding quick relief. Unfortunately, this need for immediate escape from discomfort can lead them to engage in self-soothing behaviours that are potentially harmful, such as using potentially addictive substances to seek temporary relief. These behaviours provide a reprieve from the relentless influx of sensory and emotional input that they are otherwise unable to filter or moderate, but can also lead to the development of addiction.
Coping Strategies and the Risk of Addiction
So it’s very clear that in order to manage their emotional and sensory overload, individuals with ADHD might turn to substances like alcohol, drugs, or activities such as gambling or binge eating, which can quickly become addictive. These substances or behaviours often offer a momentary boost in dopamine or a temporary numbing effect, making them attractive solutions to someone struggling with constant dysregulation. Over time, what starts as a coping mechanism can evolve into a dependency, as the body and mind begin to rely on these substances or behaviours to manage everyday emotional and sensory challenges. This cycle of dysregulation and self-soothing through potentially addictive means highlights the critical need for targeted interventions that address both the symptoms of ADHD and the potential for addiction.
Low Self-Esteem and Its Relationship with Addiction
Chronic issues such as failing to complete tasks, habitual lateness, and misplacing everyday items can erode self-esteem over time. For someone with undiagnosed ADHD, these repeated failures can contribute to a persistent sense of inadequacy, embarrassment and shame, which are high-risk factors for developing addictive behaviours. Substance use, in this context, can be a coping mechanism to momentarily alleviate these feelings of low self-worth.
The Paradox of Stimulant Use
Interestingly, many individuals with ADHD are drawn to strong stimulants, which are, paradoxically, the one of the main and most effective substances used medically to manage ADHD symptoms under proper supervision. This highlights the complex relationship between the disorder and the mechanisms of addiction, where stimulants can provide the necessary neurological stimulation that the ADHD brain lacks, but even in a medical setting, the risks of addiction are constant. However there is a growing element of the medical fraternity who believe that treating ADHD early, with medication, in a controlled manner can prevent the development of addiction by removing so many of the causes or trigger points.
Challenges in Treating ADHD During Recovery
The treatment of ADHD in individuals who are in recovery from addiction is fraught with challenges, particularly regarding the use of potentially addictive stimulant medications. Many in the recovery community are wary of using such treatments and seek alternative methods such as non-addictive medications, cognitive behavioural therapy (CBT), and lifestyle changes. These can include dietary adjustments, increased physical activity, and stress reduction techniques, which help manage ADHD symptoms without the risks associated with stimulants.
My own experience is that thus far, I have decided to not go down the medication route - however I am personally supportive of those who decide to do so, and I may well go down that route in future.
Ongoing Research and Perspectives
As research into ADHD and addiction becomes more comprehensive, and the experiences of those with both conditions become more commonplace, the undeniable link between these disorders becomes clearer.
This growing area of knowledge highlights that effectively diagnosing and managing ADHD is critical not only in its own right, but quite possibly for preventing addiction from developing, and for supporting those in recovery. The debate surrounding the best treatment strategies for individuals with ADHD who are at risk of addiction is ongoing and critical. It highlights the necessity of treatment plans that are medically sound and customised to the individual needs of each person. Ongoing exploration, openness and discussion are crucial. They empower the development of better-informed, holistic approaches that address the unique challenges at the crossroads of ADHD and addiction. As our understanding of these complex relationships expands, so must our open-minded strategies for support and intervention, ensuring they are both effective and considerate.
MATT THOMAS
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REFERENCES AND FURTHER READING
Addiction emerges from a complex interplay of neurobiological, psychological, and social factors (the bio-psycho-social model).
ADHD and addiction often co-occur, suggesting a common underlying mechanism involving dopamine dysfunction and reward-seeking behaviours.
Rejection Sensitive Dysphoria (RSD) in ADHD can lead to emotional dysregulation and a heightened risk for addictive behaviors as a coping mechanism.
Overstimulation and sensory overload in ADHD can drive individuals to seek relief through addictive substances or behaviours.
Low self-esteem resulting from ADHD-related challenges can increase the risk of developing addictive behaviours as a coping mechanism.
Treating ADHD in individuals recovering from addiction is challenging due to concerns about stimulant medications and the need for alternative approaches.
